During the last 30 years, the development of instrumentation for internal spinal fixation has evolved rapidly to provide a variety of surgical options. In order to preserve motion segments, avoid long fusion, and provide a stable construct, posterior short-segment pedicle instrumentation (SSPI) has been widely used in unstable vertebral fracture for short segment fixation. Although fusion rates have improved with the use of SSPI, a high rate of instrumentation failure is still a significant problem. In most cases, instrumentation failure occurs due to either implant failure or bone failure. Implant failure occurs when a screw bends or breaks. Bone failure occurs when the bone is weak and/or osteoporotic, resulting in loosening, toggling, or pullout of the screws. In cases of failure, a second operation is necessary, leading to increased risk of complications and higher medical costs. Anterior loading to a posterior construct is a major reason for failure of SSPI. Large axial loading and physiological movement generates significant bending moment to a posterior construct. SSPI combined with anterior fusion has been recommended in order to reduce the anterior-posterior bending moment to posterior constructs. However, a second operation has to be performed from an anterior approach, increasing risk and medical costs.